Neural Prolotherapy (NPT) is one of the newest exciting advances in Regenerative Medicine used to treat neuropathic pain in a variety of musculoskeletal injuries and various pain conditions. Neural Prolotherapy is also known as Neurofascial Prolotherapy, Subcutaneous Prolotherapy, or the Lyftogt technique. Neural Prolotherapy is the injection of a medical-grade sugar (either dextrose or mannitol) just below the skin to promote healing of injured nerves and restoration of tissue function.
When tissue is injured, it causes a release of pro-inflammatory substances (e.g. Bradykinin, Prostaglandins) that activate a channel on nerves called the “Transient receptor potential V1” (TrpV1) cation channel, also known as the capsacin receptor. When this channel is turned on, it results in nerve release of substances that cause inflammation (substance P and calcitonin gene related peptide (CGRP)) leading to leaky blood vessels (swelling), hypersensitivity, and painful sensations.
It is postulated that dextrose and mannitol, the active ingredients of Neural Prolotherapy, bind to and inhibit the TrpV1 nerve receptors, preventing this cascade and restoring normal nerve function.
Neural Prolotherapy was developed by New Zealand physician Dr. John Lyftogt, who has been using this method to treat musculoskeletal injuries and various pain conditions over the last decade with outstanding results.
The theory behind Neural Prolotherapy is based on “Hilton’s Law”, named after British surgeon Dr. John Hilton. An extraordinary anatomist, Dr. Hilton noted that the nerve that innervates a joint also innervates the skin overlying that joint and the muscles that move that joint. Using this simple model, Dr. Lyftogt hypothesized that irritation to a nerve that supplies sensation to the skin over a joint may also cause dysfunction and pain to the muscles and tissue around that joint.
It has long been known that dextrose in traditional prolotherapy promotes healing in connective tissues such as ligaments and tendons. Because nerves also contain connective tissue, Dr. Lyftogt postulated that dextrose could allow for the same healing in nerves. He injected small amounts of dextrose under the skin which resulted in decreased swelling, reduced pain, and improvement of function.
Dr. Lyftogt postulated that restoration of subcutaneous nerve function (those just beneath the surface of the skin) will lead to healing in deeper structures and reduction in pain. This method to treat musculoskeletal injuries and pain conditions has been used over the last decade with outstanding results, and Neural Prolotherapy is now being taught around the world.
Neural Prolotherapy and Traditional Prolotherapy share many similarities, but also some key differences. Both treatments promote healing and result in pain relief and functional restoration, but each uses different concentrations of dextrose as well as a different technique for injections.
Traditional Prolotherapy uses a higher concentration of dextrose and is injected deeper in the affected area to promote healing and repair of connective tissues such as ligaments and tendons. Neural Prolotherapy uses a much lower concentration of dextrose and is injected at multiple points just below the surface of the skin to target subcutaneous nerves to reduce neurogenic inflammation. Because it is injected just under the skin, Neural Prolotherapy is less invasive than traditional Prolotherapy.
Neural Prolotherapy solution contains either 5% Dextrose in sterile water (D5W) or 5% Mannitol in sterile water (M5W). Both Dextrose and Mannitol are sugars originally derived from a plant sources.
Neural Prolotherapy is generally very well tolerated, even without local anesthetic which is generally required for other types of injections. The injections are administered with very small and short needles just beneath the surface of the skin. Multiple injections are performed along the course of subcutaneous nerves. Some points may result in mild discomfort, and cold spray can be used to make the patient more comfortable.
Most patients notice an immediate reduction of pain immediately after the first injection. This initial analgesic effect may last anywhere between hours to days. Pain is generally reduced by 10-20% with each subsequent treatment as the tissue is progressively healed.
While each case is unique and treated on an individual basis, most patients respond to 5-8 treatments depending on how long the injury has been present as well as the degree of the damage. Treatments are typically spaced 1-2 weeks apart.
Neural Prolotherapy is considered safe when administered by a properly trained physician. In fact, the solution (D5W) is the same solution used in IV bags in emergency rooms and hospitals. Injections are done under sterile conditions with minimal risk of infection. While uncommon, possible adverse effects include local swelling, bruising and mild temporary pain.
No. Neural Prolotherapy is still not covered by insurance companies at this time.
Neural Prolotherapy is effective in treating nerve pain associated with injuries to joints, muscles, tendons, and ligaments. Treatment areas include the neck, back, knee, shoulder, hip, elbow, wrist, hand, foot, and ankle.
Neural Prolotherapy has also been shown to be effective with chronic pain after surgical procedures such as total knee replacements and Failed Back Surgery Syndrome. These patients often find relief when other traditional treatment options have failed.